PRiPSAIC

Background

Preventable patient harm is an important challenge in anaesthesiology and perioperative care. As a response, the Helsinki Declaration on Patient Safety in Anaesthesiology was launched in 2010 by the ESAIC and European Board of Anaesthesiology, and has been widely recognised as a practical framework for improving patient safety. It set out a vision for patient safety in anaesthesiology and laid down specific standards which European anaesthesiologists might aspire to in practice. It was signed by all European national societies of anaesthesiology and many international societies. Further, although the speciality of anaesthesiology has been at the forefront of patient safety, it is a policy priority in healthcare generally worldwide.

Our previous project (‘Evaluation of the extent of implementation of the Helsinki Declaration for Patient Safety in anaesthesiology: a mixed-methods action research project’) ran for two years, between April 2018 and March 2020. It was generously supported by our ESAIC industry partners.

You can read more about this project here.

One of the recommendations from the project to further improve safety was to pilot and evaluate the establishment of small networks of interested anaesthesiologists and hospitals to carry out peer review visits assessing patient safety in each other’s hospitals, using the visit tool developed as part of the third phase of the project above.

As part of the data collection of the project, we asked anaesthesiologists at participating hospitals to complete a questionnaire to capture their perceptions of the visit process. One question asked about the feasibility of conducting the process without an external ‘visitor’. We had responses from 14 of the 21 participating departments. The general view was that having someone objective, impartial and confidential from the same country to visit, supported by national anaesthesiology societies, would be better than a pure self-assessment. This project takes its inspiration from this finding and aims to put it into practice.

Our work showed that there was widespread appreciation of, and compliance with, the Helsinki Declaration. However, we identified other areas needing attention:

• The relationship between departments of anaesthesiology and the rest of the hospital
• The changing nature of surgical patients – many are older and sicker than 10 years ago
• Financial and production pressures in anaesthesiology
• Migration of anaesthesiology personnel across national borders
• Departments of anaesthesiology tend to work independently and there is little ‘networking’
• The need for a way of evaluating patient safety locally without relying on external ‘experts’

Since then, the COVID-19 pandemic has put great strain on those working in anaesthesiology and intensive care and has also shown the public and governments how vital our work is within the healthcare system. It has also become clear that we need to learn from each other, learn lessons from the pandemic, and collect and learn from good, meaningful data about safety. There has never been a better time to invest in safety in anaesthesiology and intensive care, and this project will make the most of this opportunity.

Work to be undertaken

We will work with national anaesthesiology societies through the ESAIC’s National Anaesthesia Societies Committee to identify four countries where there is high-level national support for piloting the project. Within each of these countries, we will identify anaesthesiologists in five hospitals who are interested in committing their time to take part and connect them together into networks.

The networks will then arrange their patient safety visits. These will differ from, and complement, any existing inspections and accreditations in the countries concerned, as they will be led by anaesthesiologists who understand their colleagues’ context of practice, and are designed to help participating hospitals explore their own safety culture and practices from within.

We will work on a ‘cascade’ principle. The first country to start the work hosts one or two representatives from the network in the second country. This will continue throughout the project, allowing not only for some standardisation of the implementation process across different countries but also providing an opportunity for participants to observe patient safety practices and cultures in different nations.

The visits will consist of a review of safety documents, safety attitude questionnaires, interviews with key stakeholders and observation of practice. Particular areas of interest will be:

• How anaesthesiology and Intensive Care interact with, and influence, the rest of the hospital: problems and opportunities
• Workforce problems and solutions: number, skill mix and wellbeing
• Safety in the Intensive Care Unit
• Perioperative care: preoperative assessment and postoperative management
• Data on safety and quality– how data are used, collected analysed and acted upon, and how digitalisation helps or could help, work in the future
• Day case surgery and the potential for expanding it whilst maintaining safety and quality
• Learning from the legacy of the COVID-19 pandemic
• Learning from error
• Opportunities for networking with colleagues regionally and nationally
• Opportunities for making healthcare safer and of higher quality whilst at the same time maintaining staff satisfaction and morale

We will also develop a comprehensive and effective communication strategy to promote the project.

Data will be collected allowing us to evaluate both the effect on safety in the participating hospitals and the perceptions of the network of visitors, with a log of positive and negative influences to ensure that a larger-scale ‘roll out’ of the project is successful.